Annals Consult Guys - Medical Emergency at 37,000 Feet: Is There a Medical Professional on Board?
Authors: Howard H. Weitz, Geno J. Merli, Christian Martin-Gill
Journal: Annals of Internal Medicine (2022)

Web ExclusivesNovember 2022Annals Consult Guys - Medical Emergency at 37,000 Feet: Is There a Medical Professional on Board?FREEHoward H. Weitz, MD, Geno J. Merli, MD, and Christian Martin-Gill, MDHoward H. Weitz, MDThomas Jefferson University, Philadelphia, Pennsylvania (H.H.W., G.J.M.)Search for more papers by this author, Geno J. Merli, MDThomas Jefferson University, Philadelphia, Pennsylvania (H.H.W., G.J.M.)Search for more papers by this author, and Christian Martin-Gill, MDUPMC, Pittsburgh, Pennsylvania (C.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/W21-0012 CME/MOC SectionsSupplemental MaterialAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Annals Consult Guys discuss a range of issues related to responding to a medical emergency during an airplane flight as well as how to counsel patients prior to air travel to reduce the risk of such emergencies.For more videos from and information on Annals Consult Guys, visit go.annals.org/ConsultGuys. Comments0 CommentsSign In to Submit A Comment Yehia Y. MishrikiLehigh Valley Health Network17 November 2022 Other simple things that can be done during a flight emergency Thank you for that informative summary. I would add couple of simple interventions: 1. Smelling isopropyl alcohol is effective in reducing mild to moderate nausea. I suspect the onboard medical kit will have alcohol swabs. 2. There are several acupressure points which can reduce nausea and which physicians should be familiar with. 3. If the ambient noise is too loud, one can still simultaneously check the vibration in both hemithoraces while the patient phonates to determine whether there might be a significant pneumothorax. Finally, and somewhat unrelated to this topic, it has been a long-standing bugaboo of mine that residents, and attendings continue to perform physical exams in the ED. One paper described noise of more than 80 dB in a typical ED. Once stablized, ED patients should immediately be transferred to their rooms where a calmer and more accurate history and physical can be performed. Miguel Ángel Cobos Gil, Jos´é Luis Unzueta Roch, Elena Cobos LópezInstituto Cardiovascular . Hospital Clínico San Carlos. Madrid. Spain22 November 2022 A powerful diagnostic tool in the wrist Dr. H. H. Weitz, Dr. G.J. Merli, and Dr. C. Martin-Gill should be congratulated for the pertinent review of in-flight medical emergencies (IME). Passenger numbers are growing steadily in the post-covid era, and their increased age and comorbidity will likely translate into an increase in IMEs. In their interesting contribution, the authors offer precise instructions for handling the most frequent emergencies, based fundamentally on the classic review by Dr Martin-Gill published in JAMA in 2018. Since then, however, a powerful tool has been incorporated into the limited diagnostic armamentarium of a medical professional attending an IME. Today there are nearly 100 million smartwatches in the world with the capacity to perform electrocardiograms, and on any commercial flight there will be a number of passengers carrying one of these wearable electrocardiographs on their wrist. Although these devices are mainly intended for diagnosis of atrial fibrillation, their diagnostic potential can be much greater. We have shown that, with some manipulation, they can perform electrocardiograms with several leads (1) and can have diagnostic value in patients with coronary disease and severe arrhythmias (2). We believe that in the necessarily austere care environment of the airplane cabin, these devices can be claimed as an important diagnostic tool for the management of some in-flight medical emergencies. REFERENCES 1. Cobos Gil MÁ. Standard and Precordial Leads Obtained With an Apple Watch. Ann Intern Med. 2020 Mar 17 2. Provencio A, Gil MÁC. Smartwatch electrocardiogram records ST depression, premature ventricular complexes, and ventricular fibrillation. Lancet. 2022 Nov 12;400(10364) Renu WeissIndependent contractor27 November 2022 Recent airline issues A critical emergency that happened recently was an unresponsive patient, who had a history of CVA. It was a 10-hour flight, we were fed 2 hours after take-off and nothing after that. No snacks were set out in the galley in economy class, they were set out in business class. I travel with a bag of foods, but not everyone does. The decision was made to divert the flight, and on arrival at the "earlier destination," the patient's blood sugar was noted to be 13. Airline policies should be a bit more humane, and all passengers - regardless of class of travel - on lengthy flights should be offered a snack or 2 until the next meal arrives. Dr. Cheryl Ackerman MDfellow American College of physicians. unaffiliated6 December 2022 Medical Emergencies on a plane The video presented with flight emergencies was great. This was a very helpful review. Author, Article, and Disclosure InformationAuthors: Howard H. Weitz, MD; Geno J. Merli, MD; Christian Martin-Gill, MDAffiliations: Thomas Jefferson University, Philadelphia, Pennsylvania (H.H.W., G.J.M.)UPMC, Pittsburgh, Pennsylvania (C.M.)Disclosures: Drs. Merli and Weitz report that they have no financial relationships or interests to disclose. Dr. Martin-Gill reports being employed at the UPMC Medical Communications Center—providing consultation for in-flight medical emergencies, and being a speaker for grand rounds on in-flight emergencies at Englewood Health. All relevant financial relationships have been mitigated. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=W21-0012.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Stephanie Chang, MD, MPH, Deputy Editor, reports employment with the Agency for Healthcare Research and Quality, travel compensation from the Guidelines International Network, and participation in the Patient-Centered Outcomes Research Institute methodology committee. Vineet Chopra, MD, MSc, Deputy Editor, reports grants received from the Agency for Healthcare Research and Quality and royalties from UpToDate and Oxford University Press. Deborah Cotton, MD, MPH, MA, Deputy Editor, reports that she has no financial relationships or interests to disclose. Eliseo Guallar, MD, MPH, DrPH, Deputy Editor, Statistics, reports that he is employed at Johns Hopkins University. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center and consultancy with Boston Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports employment with the Perelman School of Medicine, University of Pennsylvania, and consultancies with the U.S. Food and Drug Administration and the State of Colorado. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics November 2022Volume 175, Issue 11Page: CG1 ePublished: 15 November 2022 Issue Published: November 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.Loading ...